Inflammation (Acute, Chronic, Granulomatous, Mediators) MCQs

Pathology · 134 free questions with answers & explanations.

1. During neutrophil transmigration in acute inflammation, which molecular interaction mediates firm adhesion (the step following initial rolling) to endothelium?
2. In granuloma formation, the conversion of macrophages into epithelioid cells requires sustained stimulation by which cytokine, produced primarily by activated CD4+ Th1 lymphocytes?
3. Leukocyte adhesion deficiency type I (LAD-I) patients suffer from recurrent severe bacterial infections without pus formation. The molecular basis is deficiency of which protein?
4. A 40-year-old woman with rheumatoid arthritis has sustained joint inflammation despite methotrexate therapy. Synovial biopsy shows dense plasma cell and lymphocyte infiltrates with lymphoid follicle formation. Elevated levels of which cytokine in synovial fluid best explains the persistence of synovitis and activation of osteoclasts causing joint erosion?
5. Leukocyte adhesion deficiency (LAD) type I presents with recurrent bacterial infections, absent pus formation, and elevated blood neutrophil counts. The defective protein in LAD-I is:
6. In chronic granulomatous inflammation, the multinucleated giant cells form by fusion of macrophages under cytokine stimulation. The cytokine most critical for macrophage activation and granuloma maintenance is:
7. Leukotriene B4 (LTB4) is a potent chemoattractant derived from arachidonic acid via the 5-lipoxygenase pathway. Its primary cellular target in acute inflammation is:
8. In resolution of acute inflammation, apoptotic neutrophils are cleared by macrophages through a process called efferocytosis. Which phospholipid, normally confined to the inner membrane leaflet, appears on the outer leaflet of apoptotic cells to serve as an 'eat-me' signal?
9. A pathologist examines a liver biopsy from a patient with Schistosoma mansoni infection and finds non-necrotizing granulomas with central eosinophilic material surrounding schistosome eggs, with surrounding eosinophils, giant cells, and concentric fibrosis ('pipe-stem fibrosis'). Which cytokine drives the granulomatous response and periportal fibrosis in this context?
10. The resolution phase of acute inflammation involves a class of lipid mediators collectively termed 'specialized pro-resolving mediators' (SPMs). Which statement accurately describes their mechanism?
11. A 32-year-old man with Crohn's disease on infliximab develops fever, night sweats, and pulmonary infiltrates. BAL culture reveals Histoplasma capsulatum. Suppression of which inflammatory pathway by infliximab predisposes to this fungal infection?
12. A 45-year-old woman is found to have sarcoidosis with bilateral hilar lymphadenopathy. Biopsy shows tight, well-formed non-necrotizing granulomas with Langhans giant cells. Serum ACE is elevated. CD4:CD8 ratio in BAL is 5:1. Which immunological mechanism is central to sarcoid granuloma formation?
13. Lipoxins are specialized pro-resolving mediators (SPMs) derived from arachidonic acid that promote resolution of inflammation. In contrast to prostaglandins and leukotrienes, lipoxins are characterized by:
14. A biopsy from a patient with Crohn disease shows non-caseating granulomas. In granuloma formation, the key cytokine that drives macrophage fusion into multinucleated giant cells and maintains granuloma integrity is:
15. NETs (neutrophil extracellular traps) are implicated in pathological thrombosis and tissue damage. What is the cellular mechanism of NET formation?
16. In a patient with berylliosis (chronic beryllium disease), non-caseating granulomas form via CD4+ T-cell recognition of beryllium ions presented by HLA-DP molecules. This differs from tuberculosis granulomas in that:
17. Chediak-Higashi syndrome is characterized by recurrent pyogenic infections, partial albinism, and peripheral neuropathy. The defect lies in which specific cellular function?
18. In granulomatous inflammation, the conversion of macrophages to epithelioid cells and their subsequent fusion into multinucleated giant cells is driven primarily by:
19. Which pattern of inflammation is characterized by necrosis of the center of granulomas, producing a cheese-like gross appearance, and is the hallmark of tuberculosis?
20. During acute inflammation, the NET (neutrophil extracellular trap) formation involves release of chromatin and granule proteins to trap and kill microorganisms. However, excessive NETosis is implicated in the pathogenesis of which of the following conditions?
21. A 45-year-old with sarcoidosis has non-caseating granulomas. The core of the granuloma contains epithelioid macrophages and Langhans giant cells. Which cytokine produced by CD4+ Th1 cells is most critical for maintaining granuloma integrity by preventing macrophage dispersal?
22. Hageman factor (factor XII) activation at sites of injury triggers which inflammatory mediator system that is primarily responsible for the increased vascular permeability seen in hereditary angioedema (C1 inhibitor deficiency)?
23. In neutrophil extracellular trap (NET) formation (NETosis), chromatin decondenses and is expelled extracellularly. Which enzyme is essential for histone citrullination that allows chromatin decondensation during NETosis?
24. In sarcoidosis, the granulomas are non-caseating and driven by CD4+ Th1 cells. The key cytokine that drives macrophage fusion into multinucleated giant cells and sustains granuloma formation is:
25. Leukotriene B4 (LTB4) is produced from arachidonic acid via the 5-lipoxygenase pathway. Its primary function in acute inflammation is:
26. A patient post-liver transplant develops organ rejection with lymphocyte infiltration and bile duct epithelial apoptosis. The mechanism of T-cell-mediated bile duct injury involves primarily:
27. During resolution of acute inflammation, the switch from pro-inflammatory to pro-resolving lipid mediators is characterized by:
28. During resolution of acute inflammation, which lipid mediator is primarily responsible for switching macrophage phenotype from M1 (pro-inflammatory) to M2 (pro-resolving) and promoting efferocytosis of apoptotic neutrophils?
29. In a granuloma from a patient with sarcoidosis, the central collection of epithelioid macrophages is surrounded by CD4+ T lymphocytes. The epithelioid macrophages are characterized by which functional change compared to normal macrophages?
30. A 28-year-old man with recurrent subcutaneous abscesses caused by Staphylococcus aureus and Serratia marcescens has neutrophils that show normal phagocytosis but fail to produce a respiratory burst after stimulation with PMA or opsonized bacteria. Nitroblue tetrazolium (NBT) test is negative. The most likely genetic defect is in which protein?
31. Macrophage polarization into M1 (classically activated) versus M2 (alternatively activated) phenotype is orchestrated by distinct cytokine signals. Which cytokine signature drives M2 polarization and is associated with tissue repair and fibrosis?
32. Deficiency of which complement component produces the most severe recurrent Neisseria infections due to inability to form the membrane attack complex?
33. NOD-like receptor protein 3 (NLRP3) inflammasome activation in macrophages requires two signals. Which of the following represents the SECOND signal ('Signal 2') that directly activates the NLRP3 complex?
34. In Crohn's disease, NOD2/CARD15 mutations on chromosome 16 are the strongest known genetic risk factor, particularly for ileal disease. NOD2 is an intracellular PRR expressed in Paneth cells and macrophages. How do loss-of-function NOD2 mutations paradoxically lead to MORE inflammation rather than less, in the intestinal mucosa?
35. In resolving acute inflammation, specialized pro-resolving mediators (SPMs) are generated. Lipoxin A4 (LXA4) is derived from arachidonic acid via the 15-lipoxygenase pathway. Which of the following correctly describes the mechanism by which LXA4 actively terminates neutrophil-dominant inflammation?
36. IL-17A, produced primarily by Th17 cells, plays a critical role in the pathogenesis of which of the following diseases, and acts mainly by stimulating what cellular response?
37. Caspase-1 activation within the NLRP3 inflammasome leads to IL-1beta maturation and pyroptosis. NLRP3 is activated by a diverse range of danger signals including ATP, monosodium urate (MSU) crystals, cholesterol crystals, and silica. The common intracellular signal that converges from all these stimuli to activate NLRP3 is:
38. Langhans giant cells in tuberculosis granulomas are formed by fusion of which cells, and what cytokine is critical for this fusion process?
39. A patient with recurrent bacterial pneumonias is found to have a mutation in ITGB2 (CD18) gene. This results in absent surface expression of CD11a/CD18 (LFA-1), CD11b/CD18 (Mac-1), and CD11c/CD18 on leukocytes. What is the specific defect in leukocyte trafficking?
40. A biopsy from a pulmonary lesion shows non-necrotising granulomas without caseation composed of epithelioid histiocytes and Langhans-type giant cells. No organisms are found on special stains (ZN, PAS, GMS). Serum ACE is elevated. Which cytokine is most critical for the induction and maintenance of this granuloma type?
41. During acute inflammation, leukotriene B4 (LTB4) is produced by neutrophils via 5-lipoxygenase. Which specific phospholipid precursor is first liberated and what is the direct enzyme responsible for LTB4 generation from 5-HPETE?
42. A patient develops a chronic non-healing wound. Pathological examination shows dense macrophage infiltration, plasma cells, lymphocytes, and angiogenesis with connective tissue deposition. The macrophages show M2 polarisation (CD163+, CD206+). Which cytokine profile is most responsible for the M2 macrophage polarisation seen in chronic wound/fibrotic tissue?
43. Histamine is released from mast cells in allergic reactions and causes increased vascular permeability. However, in the early phase of acute inflammation (first 30 minutes), histamine-mediated permeability is confined to venules but not capillaries or arterioles. What structural feature of venular endothelium explains this selectivity?
44. In granulomatous inflammation caused by Mycobacterium tuberculosis, which innate pattern recognition receptor (PRR) pathway is primarily responsible for recognizing mycobacterial components and initiating the granuloma-forming Th1 response?
45. A pathologist examining a lymph node from a patient with cat-scratch disease observes stellate microabscesses surrounded by a rim of palisading histiocytes. Which term accurately describes this specific pattern of granulomatous inflammation?
46. IL-17A and IL-17F produced by Th17 cells play a central pathogenic role in several autoimmune conditions. Their primary effector mechanism on epithelial and stromal cells involves:
47. In Crohn's disease, non-caseating granulomas are found in 30–60% of biopsies. The macrophage differentiation pathway required for granuloma maintenance involves which transcription factor and cytokine axis?
48. In the formation of a tuberculous granuloma, which cytokine secreted by sensitized CD4+ T cells (Th1 cells) is most critical for maintaining macrophage activation and granuloma integrity?
49. Complement fragment C5a plays multiple roles in acute inflammation. Which of the following is NOT a direct action of C5a?
50. A patient on long-term corticosteroid therapy develops a wound that fails to heal. Which specific mechanism explains corticosteroid-mediated impairment of wound healing?
51. In the context of NETosis (neutrophil extracellular trap formation), which enzymatic step is essential for chromatin decondensation and NET extrusion, and which pathological condition is it most directly implicated in?
52. The resolution of acute inflammation is an active process driven by specialized pro-resolving mediators (SPMs). Which lipoxin is generated from arachidonic acid via 15-lipoxygenase and acts as a 'stop signal' for neutrophil recruitment while promoting macrophage efferocytosis?
53. The formation of NETs (neutrophil extracellular traps) during infection involves release of:
54. In granulomatous inflammation caused by Mycobacterium tuberculosis, the 'caseous necrosis' within granulomas is primarily due to:
55. Leukotriene B4 (LTB4) is a potent chemotactic agent derived from arachidonic acid via the 5-lipoxygenase pathway. Its principal chemotactic target is:
56. During acute inflammation, neutrophils roll along the endothelium via selectin-mediated interactions. Which selectin on the endothelium binds sialyl-Lewis X on neutrophils during rolling?
57. A 35-year-old woman with sarcoidosis has a non-caseating granuloma in the lung biopsy. The Schaumann bodies and asteroid bodies within giant cells are best described as:
58. Which arachidonic acid metabolite is responsible for causing fever by acting on the hypothalamic thermoregulatory center, and what is its precursor mediator?
59. In chronic granulomatous disease (CGD), which enzyme defect causes recurrent catalase-positive bacterial and fungal infections?
60. NETs (neutrophil extracellular traps) are chromatin fibres decorated with granule proteins released by neutrophils. In which of the following scenarios are NETs MOST detrimental rather than protective?
61. In granuloma formation, the conversion of monocytes to epithelioid histiocytes is primarily driven by which cytokine secreted by activated CD4+ T cells?
62. A surgical specimen from a patient with Crohn's disease shows transmural chronic inflammation with non-caseating granulomas, fissuring ulcers, and skip lesions. The granulomas in Crohn's disease are composed primarily of which cells and lack a central feature typical of tuberculosis?
63. A 30-year-old man has a localized abscess. The neutrophil accumulation in this abscess is driven by directional migration toward chemokines. Which complement fragment is the MOST potent chemotactic agent for neutrophils?
64. In granulomatous inflammation, the epithelioid cell is derived from:
65. Prostaglandin E2 (PGE2) produced during acute inflammation causes fever by acting on which brain structure?
66. Which adhesion molecule on endothelium is primarily responsible for ROLLING of neutrophils during acute inflammation?
67. In chronic inflammation, which cell type is the PRINCIPAL source of growth factors that drive fibrosis and tissue remodeling?
68. A 30-year-old woman with sarcoidosis has mediastinal lymphadenopathy. Biopsy shows non-necrotising granulomas with multinucleated giant cells. Which of the following cytokines is MOST critical for maintaining granuloma integrity in sarcoidosis?
69. During acute inflammation, the cellular event that follows neutrophil rolling is selectin-mediated slowing but the firm adhesion step requires:
70. Arachidonic acid-derived lipoxins differ from prostaglandins and leukotrienes in that they primarily function to:
71. Which lipid mediator is produced by mast cells and basophils by the action of lipoxygenase on arachidonic acid and is responsible for bronchoconstriction and mucus hypersecretion in asthma?
72. In granulomatous inflammation, epithelioid macrophages fuse to form Langhans giant cells. The key cytokine driving macrophage differentiation into epithelioid cells and their fusion is:
73. The complement fragment C5a is a potent neutrophil chemoattractant that also causes mast cell degranulation. Through which receptor on neutrophils does C5a mediate its chemotactic effect?
74. A 30-year-old patient with Crohn disease shows transmural inflammation with non-caseating granulomas. Genetic susceptibility in Crohn disease is primarily linked to a loss-of-function mutation in which gene affecting bacterial sensing?
75. Which complement component, generated during acute inflammation, directly causes mast cell degranulation and increased vascular permeability without requiring immune complex formation?
76. The cardinal function of leukotriene B4 (LTB4) in acute inflammation is:
77. Granuloma formation requires which cytokine signal from macrophages that drives differentiation of CD4+ T-helper cells into IFN-γ-producing Th1 cells to sustain macrophage activation?
78. Neutrophil extracellular traps (NETs) are structures composed of:
79. Which complement anaphylatoxin is the most potent direct trigger of mast cell degranulation and also the most powerful chemotactic agent for neutrophils?
80. Granuloma formation requires which macrophage-derived cytokine that drives CD4+ T-helper cell differentiation into IFN-γ–producing Th1 cells to sustain macrophage activation?
81. Neutrophil extracellular traps (NETs) are composed of:
82. In acute inflammation, neutrophils roll along the endothelium via selectin-mediated interactions before firm adhesion. The molecule on activated endothelial cells that mediates this initial neutrophil rolling is:
83. A 35-year-old is found to have granulomatous inflammation on lymph node biopsy. Caseous necrosis is present in the center of the granulomas. Ziehl-Neelsen staining reveals acid-fast bacilli. The key cytokine produced by CD4 T helper cells that drives macrophage activation and granuloma formation is:
84. Leukotriene B4 (LTB4) is a potent chemoattractant for neutrophils. It is generated from arachidonic acid by which enzymatic pathway?
85. Chronic granulomatous disease (CGD) results from NADPH oxidase deficiency. Patients suffer from recurrent infections with catalase-positive organisms because:
86. A 50-year-old man develops widespread fibrinous pericarditis 2 weeks after a large myocardial infarction. This pattern of secondary inflammation illustrates which type of exudate?
87. In tissue repair, myofibroblasts are responsible for wound contraction. The key cytokine that stimulates fibroblast differentiation into myofibroblasts is:
88. Which complement fragment serves as the most potent chemotactic agent for neutrophil recruitment during acute inflammation?
89. Epithelioid granulomas with central caseating necrosis, Langerhans giant cells, and peripheral lymphocytic cuffing are most characteristic of which type of granulomatous inflammation?
90. Leukotriene B4 (LTB4) is primarily derived from arachidonic acid via which enzymatic pathway and exerts what key inflammatory effect?
91. Chronic granulomatous disease (CGD) results in recurrent infections due to impaired killing of catalase-positive organisms. The underlying defect involves which component of the NADPH oxidase complex?
92. Leukotriene B4 (LTB4) is a potent chemotactic agent for neutrophils. It is derived from which substrate by which enzyme?
93. In granulomatous inflammation, epithelioid cells are derived from which cell type?
94. Which cytokine is primarily responsible for the transition from acute to chronic inflammation by promoting macrophage activation and granuloma formation?
95. Exudate differs from transudate in that exudate has a specific gravity > 1.020. The fundamental mechanism that produces exudate in acute inflammation is:
96. The Arthus reaction is the prototypical example of which type of hypersensitivity, and what is the key pathological mediator?
97. A patient with recurrent bacterial infections has neutrophils that show impaired killing of catalase-positive organisms despite normal phagocytosis. The NBT (nitroblue tetrazolium) test is negative. Which enzyme is deficient?
98. Leukotriene B4 (LTB4) differs from leukotriene C4 (LTC4) primarily in that LTB4 functions mainly as a:
99. Non-caseating granulomas with asteroid bodies and Schaumann bodies are characteristic of which condition?
100. IL-10 is best characterized as an anti-inflammatory cytokine because it:
101. Which complement pathway is activated by mannose-binding lectin (MBL) recognizing carbohydrate patterns on microbial surfaces?
102. Which chemical mediator of acute inflammation primarily causes PAIN by sensitizing peripheral nociceptors?
103. A non-caseating granuloma in sarcoidosis contains epithelioid macrophages and Langhans giant cells. What is the primary cellular mechanism forming multinucleated giant cells?
104. Which lipid mediator class has an active 'stop signal' role in resolving acute inflammation by inhibiting neutrophil recruitment and promoting macrophage efferocytosis of apoptotic neutrophils?
105. A 60-year-old man with gout has a tophus on his ear. Histologically, urate crystals are surrounded by which type of giant cells, and what cytokine drives their formation?
106. Resolution of acute inflammation is an active process, not merely a passive cessation of pro-inflammatory signals. Which lipid mediators are responsible for actively driving this resolution phase?
107. In granuloma formation, which cytokine produced by sensitized T lymphocytes is MOST critical for inducing and maintaining macrophage differentiation into epithelioid cells and giant cells?
108. The complement membrane attack complex (MAC, C5b-C9) causes cell lysis. Which complement regulatory protein on host cell surfaces specifically prevents MAC assembly by binding C8 and inhibiting C9 polymerization?
109. A patient with hereditary angioedema has recurrent episodes of subcutaneous and submucosal swelling without urticaria. The mediator responsible for the edema in this condition is:
110. Which cytokine is the principal mediator of the acute phase response, responsible for inducing fever, hepatic acute phase protein synthesis, and leukocytosis?
111. In granulomatous inflammation, the epithelioid cells are derived from which cell type, and the key cytokine maintaining the granuloma is:
112. Which type of necrosis is characteristically seen in the center of a tuberculous granuloma, and what is its histological appearance?
113. A patient with a resolving abscess undergoes wound healing. Which cytokine is primarily responsible for the transition from neutrophil-predominant acute inflammation to the macrophage-dominated resolution phase?
114. Which of the following granulomatous diseases characteristically shows NON-caseating granulomas on histology?
115. During the cellular phase of acute inflammation, the sequential steps of neutrophil emigration from blood vessels occur in which order?
116. Bradykinin is a key mediator of the pain, vasodilation, and increased vascular permeability seen in acute inflammation. It is generated from kininogen by the enzyme:
117. In a patient with hereditary angioedema (C1 inhibitor deficiency), repeated episodes of subcutaneous and mucosal swelling occur without urticaria. The mediator primarily responsible for the angioedema attacks is:
118. Neutrophil extracellular traps (NETs) are antimicrobial structures, but excessive NET formation is now implicated in tissue injury in several diseases. Which enzyme, expressed on the outer cell membrane of activated neutrophils, initiates NET formation by citrullinating histones?
119. Caseating granulomas are the histological hallmark of tuberculosis. The central caseous necrosis in tuberculosis granulomas is a form of coagulative necrosis with a distinctive 'cheese-like' gross appearance. The caseous necrosis results from which unique mechanism?
120. Complement fragment C5a is one of the most potent pro-inflammatory mediators. In addition to being a chemoattractant, C5a exerts which direct effect on vascular endothelium during acute inflammation?
121. In acute inflammation, margination of neutrophils is mediated initially by which selectin-ligand interaction?
122. In granulomatous inflammation (e.g., tuberculosis), the central area of caseous necrosis is surrounded by epithelioid macrophages and Langhans giant cells. What drives the formation of epithelioid macrophages?
123. Arachidonic acid released from membrane phospholipids by phospholipase A2 can be metabolized via the COX pathway or the lipoxygenase pathway. Leukotriene B4 (LTB4), produced by the lipoxygenase pathway, mediates which primary inflammatory action?
124. A patient on long-term steroid therapy is found to have impaired wound healing. Steroids impair healing primarily by inhibiting which process?
125. Leukocyte rolling on the vascular endothelium during acute inflammation is primarily mediated by interaction between which receptor-ligand pairs?
126. A patient with recurrent severe bacterial infections is found to have a hereditary deficiency of leukocyte adhesion molecule CD18. He shows a markedly elevated peripheral neutrophil count but poor wound healing and absent pus formation. Which adhesion step is primarily impaired?
127. Which of the following granulomatous diseases is characteristically associated with caseous necrosis within granulomas on histology?
128. Leukotriene B4 (LTB4) is generated from arachidonic acid via the lipoxygenase pathway. What is its primary role in acute inflammation?
129. Which arachidonic acid metabolite is the primary chemotactic agent for neutrophils in acute inflammation, generated via the 5-lipoxygenase pathway?
130. A patient with chronic granulomatous disease (CGD) fails to kill ingested Staphylococcus aureus. The fundamental defect is absence of functional:
131. In the resolution of acute inflammation, specialized pro-resolving mediators (SPMs) that halt neutrophil recruitment and promote macrophage efferocytosis are synthesized from which precursors?
132. Langerhans cell histiocytosis (LCH) is characterized by clonal proliferation of Langerhans cells bearing the BRAF V600E mutation. Which feature on electron microscopy is pathognomonic for Langerhans cell identification?
133. The resolution of acute inflammation requires active termination of neutrophil influx and promotion of macrophage efferocytosis. Which lipid mediators are synthesised SPECIFICALLY to resolve inflammation (as opposed to initiating it)?
134. A 25-year-old woman develops tender erythematous nodules on her shins bilaterally (erythema nodosum) 3 weeks after starting oral contraceptives. On biopsy, the septal panniculitis shows infiltration by lymphocytes and histiocytes but NO vasculitis and NO granulomas. Erythema nodosum represents which hypersensitivity mechanism?